Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Wednesday, March 21, 2007

The famous Neurosurgeon Dr. Hfuhruhurr pioneered the Cranial Screw-Top Method of brain transplantation. Unfortunately for us he took his skills to the grave.

Right now I have two patients and three family members in the ED in need of STAT brain-transplantation. It's not just me. My nurse warned me about one of these patients before going into the room. She was discharged from the nearby University hospital yesterday. She has been seen in this ED 8 times in the last month and admitted once. She has a somatiform disorder meaning that every kind of specialist available has studied her from stem to stern and found no reason for her complaints. A psychiatrist also was consulted during her last admission and solved the puzzle. This woman has such severe depression, poor insight, and poor coping skills that her depression is manifested with physical symptoms and complaints.

It does not help that she will not take her prescribed anti-depressant as it is too expensive. It does not help that she smokes pot and crack (evidently not that expensive). She came in here today faking a coma and telling me that she had not been able to keep anything down in two weeks. When asked why she didn't see her primary care provider today she told me it was because she would have to pay for it and that she shouldn't have to pay and that we were free.

This patient would be at the top of the list for the good Dr. Hfuhruhurr. A monkey brain would be better than hers. Again, this was a statement offered by her nurse with which I readily agreed. Her bill today will be in the multi thousands of dollars. Thanks, taxpayers, for footing it. To learn more about Dr. Hfuhruhurr click the title to this post above.

I thought EMTALA only required the treatment of emergency cases. This woman seems fine. She claims to have "non-emergency" symptoms that you can't recreate in the ED. Why would you treat her without getting her to front the cash. ED's are for emergencies, correct? Tell her to hit the road.

ah, good question. EMATAL does not define "emergency condition". so, we are obligated to err on the side of safety. this patient looked sick and we all thought she was FOS, BUT, every once in a while these patients are sick. it's the whole "boy who cried wolf" syndrome. i would rather work these patients up completely than be hauled into court for an EMTALA violation or a missed diagnosis.

no, she was brought in by her family for being 'unresponsive' but had normal vitals, reflexes, etc... the nurses, before i saw her, waved a little ammonia capsule under her nose and she 'woke up'. some do not approve of the use of ammonia capsules but they work when you are faking it.

I saw a woman the other day who faked a seizure by twitching her upper body and saying quite clearly "I'm having a seizure, helpmehelpme!" This oh so wonderful phrase alternated with the classic "I can't breathe" that was screamed between gasping breaths.